GU infections Flashcards
What are the general Genitourinary Tract Infections
- Acute Cystitis
- Acute Pyelonephritis
- Acute Bacterial Prostatitis
- Chronic Bacterial Prostatitis
- Infectious Stone Disease
- Epididymitis
- Fourniers Gangrene
What is acute cystitis?
- inflamm of the urinary bladder d/t:
- -bacterial infections (most common)
- -stones
- -interstitial cystitis
- -radiation
- -bladder cancer
What is the most common infection in women? At what age does this occur in men?
- bacterial cystitis, 1 of 3 women have an infection before age 24
- uncommon for men until around 50yo when prostate enlarged and can cause bladder outlet obstruction.
What are the risk factors of Acute Cystitis?
-incomplete bladder emptying, may be related to BPH, Diabetes, neurologic, MS
- sexual intercourse
- Benign Prostatic Enlargement
- Stones
What is the most common bacteria to cause acute cystitis? What are some of the other contenders?
- e.coli
- proteus, klebsiella, pseudomonas, enterococcus faecalis, and staph saprophyticus
What are some bacteria that may lead to stone formation? How does this happen?
-Proteus, klebsiella pneumoniae, and staph saprophyticus increase the urine pH leading to stone formation.
Clinical Presentation of Acute Cystitis, PE findings? What labs do you order?
- irritative voiding sx
- -frequency
- -urgency
- -dysuria
- -hematuria
- -suprapubic discomfort
-PE: suprapubic tenderness
- Labs: UA and UC
- -no imaging needed unless there is a fever associated with it.
Acute Cystitis Tx
- 1-3days of single dose abx therapy
- -1st line drugs: -Nitrofurantoin
- Trimethoprim-Sulfamethoxazole (if allergic to sulfa you can just use trimethoprim)
- Cephalosporins
–fluoroquinolones should be used for complicated infections d/t increasing resistance to E. Coli strains.
What is acute pyelonephritis?
What bacteria are the most common cause?
-an infection of the upper urinary tract including the renal pelvis and renal parenchyma
- e.coli
- proteus
- klebsiella
- enterobacter
- pseudomonas
Risk factors of Acute Pyelonephritis?
- obstruction of the urinary tract
- -stones, UPJ obstructions
- Vesicoureteral reflux
- DM
- Female Gender
Pathogenesis of Acute Pyelonephritis
- bacteria ascend from the lower urinary tract into the collecting ducts,
- -may have hematogenous route, through the arterioles in the glomerulus. Staph aureus or candida in the blood stream.
- -may have lymphatic involvement, very unusual, gain access into kidney from an intraperitoneal abscess.
Clinical Presentation of Acute Pyelonephritis? What might you find on physical exam?
- fever
- chills
- flank pain
- malaise
- nausea and vomitting
- irritative voiding sx
-costovertebral angle tenderness
What might you find on CBC, UA, UC, and blood cultures of a patient with Acute pyelonephritis?
Would you order any other tests? What would they be?
- CBC: leukocytosis
- UA: hematuria, bacteriuria, pyuria
- UC positive
- Blood cultures positive
-Renal ultrasound and abdominal & pelvic CT scan w/ and w/o contrast
Tx of Acute Pyelonephritis?
-management usually 10-14days
- Parenteral or oral abx
- -IV ampicillin or gentamicin
- -IV cefazolin
- -IM ceftriaxone (recephin)
- -Bactrim/Septra or fluoroquinolone
*wait until patient is afebrile for a few days before you switch them over to oral abx.
Acute Bacterial Prostatitis
- what is it?
- what bacteria cause it?
-infection and inflamm of the prostate
- e.coli*
- klebsiella*
- proteus mirabilis
- enterobacter
- staph aureus
Acute Bacterial Prostatitis Risk factors? Pathogenesis?
- BPH, urethral stricture disease, urethral catheterization, neurogenic bladder, calculi, DM
- bacteria ascend up the urethra into the bladder and infected urine reflux into the prostatic ducts.
Clinical Presentation and PE findings in Acute Bacterial Prostatitis?
- Present w/ vague pelvic and systemic sx
- irritative voiding
- dysuria
- perineal and low back pain
- difficulty voiding or retention
- PE: prostate may be enlarged, tender, or boggy (soft)
- avoid prostate massage (may cause them to become septic, bacteria gets into blood stream.)
What would you expect to find on CBC, UA, & UC in patient with acute bacterial prostatitis?
What is the treatment?
- CBC: leukocytosis
- UA: positive leukocytes, blood, and nitrates
- UC: positive
Treatment:
- acutely ill pts require hospitalization
- manage w/ broad spectrum abx (ampicillin and gentamicin) until culture is back
- switch to oral abx after pt is afebrile or 24-48hrs
- 4-6sweeks with-Trimethoprim-sulfamethoxazole or a fluoroquinolones
*for urinary retention a percutaneous suprapubinc tube should be placed.
Chronic Bacterial Prosatitis
- most common bacteria causing dz
- clinical presentation
- pathogenesis
- what types of testing are done?
- e.coli
- same as acute bacterial prostatitis (ABP)
- bacteria ascend up the urethra and into the prostate like ABP
-Meares-Stamey four glass test:
Urinate, the 1st cup to get beginning of urine, 2nd is mid-stream catch then vigorously massage the prostate for 1 min and then goes and urinates in 3rd cup. 4th cup is the rest of the urine in the bladder.
What is the main clinical manifestation that differentiates acute bacterial prostatitis and chronic?
-the CBP patients arent as sick, their prostate isnt boggy, it feels normal.
Treatment of Chronic Bacterial Prostatitis?
- 4-8wk of abx
- anti-inflamm drugs
- hot sitz bath
- alpha blocker (like flowmax; helps relax the smooth muscle of the prostate and help with urination.
Struvite Stones; what are these?
Who are they most common in?
how are they formed?
what bug is most common?
- stones composed of magnesium, ammonium phosphate, and carbonate apatite
- most common in females
- formed from urease producing organisms that split urea into ammonia
- Proteus mirabilis is the most common
- -other pathoges include: H. flu, staph aureus, and kelbsiella
Are struvite stones painful? Why or why not?
-Whenever you see proteus mirabilis you worry about infectious stones. These stones encompass the entire kidney, they don’t cause very much pain because they aren’t obstructing flow the urine may still pass though they will still have recurrent infections from the bacteria being present.
What is staghorn calculus?
-when struvite sotnes encompass the entire collecting system of the kidney.
Tx of Struvite Stones?
- fluoroquinolone
- percutaneous nephrolithotomy
What is acute epididymitis? What are the main causes? Who are they most common in?
- inflamm of epididymis
- main cause is chlamydia trachomatis and Neisseria gonorrhoeae in men under age 35
- main cause in older men is e.coli or pseudomonas sp.
Acute Epididymitis clinical sx? PE findings? Dx?
- severe swelling and pain of surrounding structures
- fever
- irritative voiding
Findings:
palpation reveals induration (hardening, like sclerosis) and swelling of involved epididymis with pain
-some develop hydrocele if infection to testicle
Dx: made clinically and may be confirmed with urine studies, scrotal US.
Acute Epididymitis Tx
-ceftriaxone 250mg IM one dose plus doxycycline 100mg BID x10days
alternative to doxy=azithromycin
Signs of Chronic Epidiymitis? Clinical features? Treatment?
-scrotal or testicular swelling, discomfort, usually lack irritative voiding sx
- clinical features:
- -subtle induration or tenderness with or w/o sweilling
- -may feel inflamm nodule with nontender epididymis , UA negative
Tx: conservative; hot soaks, scrotal elevation, anti-inflamm.
Fourniers Gangrene
- what is this?
- clinical features?
- diagnostic test you will want
-necrotizing fasciitis of the perineum caused by mixed infection of aerobic/anaerobic bacteria
Clincial:
- tense edema of scrotal wall
- blisters(bullae)
- subQ gas
- fever
- tachycardia/hypotension
- Diagnostics:
- CT
- MRI
Pathogens of Fourniers Gangrene
- Group A streptococcus (hemolytic sstreptococcal gangrene)
- Anaerobic species
- -bacteroides
- -clostridium
- Enterobacteriaceae
- -e.coli
- -enterobacter
- -klebsiella
- -proteus
Tx of Fourniers Gangrene?
- Surgical
- Empiric:
- -carbapenem or beta-lactam-beta-lactamase inhibitor PLUS clindmycin PLUS agent against MRSA (Vanco)
